The Test That Can Save Your Life

These days, just showing up at your gyno's office isn't enough, especially if you're one of the millions of young women who unknowingly become infected with a potentially cancer-causing STD every year. Here, Cosmo clues you in to a newer, more accurate version of the Pap test and explains everything you need to do if your results reveal a problem.

Okay, so no woman looks forward to her annual visit to the gyno. After all, there's nothing more awkward than lying on an examination table, clothed only in a flimsy paper robe, with your feet in cold metal stirrups. Naturally, you just want to tune out or count the spots on the ceiling. But it's more important than ever that you know what goes on in those brief moments during the exam when your doctor is administering your Pap test. The reason? Although the Pap test has decreased the number of deaths from cervical cancer by 70 percent since it was introduced in the 1940s, it's far from perfect. Some studies have shown that as many as 55 percent of standard Paps yield a false negative result, meaning something could be wrong but the test didn't detect it. And a small percentage come back labeled unsatisfactory for evaluation, which means you'll have to endure those stirrups all over again. But there's a relatively new version of the Pap called ThinPrep. It's not only considered to be more accurate than the one you've probably been getting from your gyno, but it can also save you from a lot of sleepless nights by pinpointing the culprit (in most cases, one particular STD) behind an abnormal result much faster, says Joseph Livoti, an obstetrician and gynecologist in West Islip, New York. So read on for the smartest and latest ways to protect your reproductive health, as well as a step-by-step guide on what to do if your Pap comes back abnormal.

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The Anatomy of a Pap TestWhat this procedure does -- and doesn't -- reveal
First, some basics: "During the test, your doctor scrapes some of the cells off the lining of your cervix," explains Suzanne Trupin, M.D., clinical professor of obstetrics and gynecology at the University of Illinois College of Medicine at Urbana-Champaign. (If you ever feel like you're in the dark, ask your gyno to describe what she's doing as she goes along.) The cells are then sent to a lab and checked for any changes that might indicate a problem. Although some abnormal Pap results are caused by inflammation or a vaginal infection, most significant cell changes are caused by one culprit -- the human papillomavirus (HPV), a sexually transmitted disease that affects up to 85 percent of women at some point in their lives and is the primary cause of cervical cancer. But having HPV is not a death sentence; in fact, it's far from it. There are more than 200 types of HPV, and the majority of them are harmless. Only 17 high-risk strains are considered precursors to cervical cancer. (The strains that cause genital warts are a low-risk type.) But even being infected with a high-risk strain doesn't mean a woman is guaranteed to develop cancer. Surprisingly, in a whopping 99 percent of cases, all strains of HPV go away on their own in about 12 to 18 months. Cervical cancer is rare and usually takes more than a decade to develop, but with 4,400 deaths from the disease in the United States last year alone, you still need to have a Pap. (Fifty percent of cervical-cancer cases happen in women who've never had the test.) Here's what the all-important Pap is capable of.

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It can:

Identify (but not diagnose) suspicious cells that may be precancerous or cancerous Diagnose a vaginal infection such as yeast It cannot:
Screen for most STDs (except for the new ThinPrep version, which we'll soon explain) Test for pregnancy Detect cancer of the uterus, fallopian tubes or ovaries

What Kind of Pap to Ask For
There's not just one way to go. Here, we compare the methods and help you choose the one that's best.Standard Pap Test
Your doctor uses a small plastic or wooden device that looks like a popsicle stick to scrape some cells from the surface of your cervix. She smears the cells onto a slide, which is then sent to a lab for testing. The downside: The cells tend to clump together on the slide, which makes it hard to read, and about 80 percent of the cells get tossed out with the scraping device.ThinPrep
Your doctor collects cells using a small plastic broom that looks like a drink stirrer and then rinses the cells into a container of liquid, which is good for two reasons: "More cells go to the lab for testing, and the technician can filter out any blood and mucus, making the sample easier to read," says Dr. Livoti. "ThinPrep actually decreases the rate of false negatives by 30 to 40 percent." That means there's a better chance your doctor will catch a potential problem early on. But that's not all: Because ThinPrep captures so many cells, you'll also have some left over, which can then be checked for HPV and even chlamydia and gonorrhea right away if your test result comes back abnormal -- an option that doesn't exist with regular Paps. Although ThinPrep is more expensive than a traditional smear ($45 to $60 versus $25 to $40), most major insurance companies cover it. And yet many women are unaware of ThinPrep -- in a survey of women on the Cosmopolitan Website, 75 percent had never heard of it. So when you schedule your next appointment, make sure to tell the nurse or your doctor that you want the ThinPrep Pap test. (See "Is Your Doctor in the Dark Ages?")Endocervical Brush
If your doctor doesn't offer ThinPrep, your next best bet is to ask her to use a tool called an endocervical brush (such as Cytobrush, which resembles a mascara wand) in addition to the standard popsicle stick. "The area where cervical cancer typically starts is hard to reach, so with a traditional sampling tool, it's easy to miss the most important cells," says Louis Kuritzky, M.D., clinical assistant professor of community and family medicine at the University of Florida at Gainesville. These brush bristles get at the hard-to-reach walls of your cervical canal. (Many doctors will even use both the brush and the ThinPrep broom to collect as many cells as possible.) The brush method is slightly more uncomfortable than a regular Pap or ThinPrep, but your doctor is more likely to get a usable cell sample.

Is Your Doctor in the Dark Ages?The first step to ensuring the best care possible starts here.
Although way back in 1996 the U.S. Food and Drug Administration declared that the ThinPrep Pap test was "significantly more effective," many docs are still using the older, less reliable smear test out of habit. In fact, only 50 percent of all Pap tests today are being done with ThinPrep, according to a spokesperson for Cytyc Corporation, the test's manufacturer.

Postexam Pointers
Before you head out the door, ask your gyno when you can expect to get your test results -- and how. Fewer than half of the women in Cosmo's online survey said that they had received a call from their doctors about their test results. "If your doctor has a no-news-is-good-news policy, tell the receptionist you'd prefer a call or a note so you can be sure your results haven't been lost," suggests Dr. Trupin. If that's not possible, ask when they anticipate your results coming in and call the office yourself. Also, find out if you'll need any follow-up procedures. "Always ask your doctor, 'When should I come back?' or 'Will I need any more tests?' so you know what's expected of you," says Dr. Trupin. Jot it down before you forget.